An article in JAMA by Mandelblatt et al (2002) compared the societal costs and benefits of human papillomavirus (HPV) testing, Pap testing, and their combination to screen for cervical cancer. The paper studied 18 different population screening strategies – Pap testing alone, HPV testing alone, and Pap plus HPV testing – every 2 or 3 years for women beginning at age 20 and continuing to 65 years, 75 years, and death. The following table summarizes some of the results (low cost to high cost). Costs include screening and treatment costs, discounted over the individual’s expected lifetime.
Strategy
Cost ($)
QALYs Saved
Incremental Cost
Incremental QALY
ICER*
0. No screening
5,000
26.87
1. Pap every 3 years to age 75
6,825
27.02
2. HPV every 3 years to age 75
6,950
3. Pap every 2 years to age 75
7,275
27.04
4. Pap + HPV every 3 years to age 75
7,400
5. HPV every 2 years to age 75
7,450
6. Pap + HPV every 2 years to age 75
7,925
27.05
a. Identify all dominant screening strategies. Explain why each is dominant.
b. Which ones are considered economically rational and why?
c. The local health district asked your opinon on the "best" strategy from a public health perspective. What do you tell them?
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